![if !IE]> <![endif]>
Describe the known cases in the literature of epidural hematoma in the parturient.
There are 10 reports in the literature of neuraxial (spinal or epidural) hematoma occurring in parturients. The cases are as follows:
· Three cases: The diagnoses were made clinically and the symptoms resolved spontaneously.
· One case: Magnetic resonance imaging (MRI) was performed in a patient with neurofibromatosis to make the diagnosis of epidural hematoma. The symptoms resolved spontaneously.
· One case: Details about the patient were not available but the patient did require surgery to evacuate an epidural hematoma. The patient was reported as “still improving”.
· Two cases: Both patients were reportedly healthy but were later found to have a subdural ependymoma, which is an unpredictable event.
· Two cases: Epidural hematomas were reported in patients who had disorders of coagulation, both of whom recovered fully or had only minor residual deficits. One of these patients presented with cholestasis of pregnancy and received labor epidural analgesia. The patient later developed an epidural hematoma and was found to have an elevated prothrombin time (PT 27.7 seconds) and partial thromboplastin time (PTT 59.1 sec-onds). The second woman presented with preeclampsia and had a history of a lupus anticoagulant. Her preoper-ative laboratory tests revealed a normal platelet count of 425,000 mm−3, a PT of 10.5 seconds, and a bleeding time of 3 minutes. Her PTT was elevated at 49 seconds but this was attributed to the lupus anticoagulant. The deci-sion was made to proceed with an epidural anesthetic for cesarean delivery. However, in the operating room, the patient had a grand mal seizure after catheter placement and a general anesthetic was performed. The epidural catheter was never used. The next day, the patient com-plained of leg weakness and an MRI showed an epidural hematoma that was subsequently evacuated.
· One case: A woman with preeclampsia, who had a platelet count of 71,000 mm−3 received an epidural anesthetic with 13 mL of bupivacaine 0.5% for cesarean delivery. One hour after the procedure, she had a seizure in the postanesthesia care unit. It was noted that there was no seizure activity in her lower extremities and a computerized tomography (CT) scan revealed an epidural collection. A laminec-tomy was performed 6 hours after epidural catheter placement, at which time 4 mL of blood was drained from the epidural space. The patient recovered 72 hours later. Whether the 4 mL was sufficient to cause her symp-toms is unknown; it is possible that the symptoms were related to residual local anesthetic effects.
Copyright © 2018-2023 BrainKart.com; All Rights Reserved. Developed by Therithal info, Chennai.